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Disordered Eating in Middle Age

“I’m 45 and I should know better” she tells me through tears in my office.

She sits before me sad and exhausted and obviously thin having recently lost significant weight following a relationship breakdown.

This isn’t uncommon. Dealing with difficult emotions like heartbreak, disappointment, betrayal and self-doubt can often lead to a decrease in appetite. For most people though, this is temporary and as their moods lift so do their appetites. For others however, this can spark a difficult and dangerous decline into a problematic thinking and eating pattern referred to as disordered eating. At best it is consuming. At worst it is life threatening. This is not unfamiliar to my client and she is intelligent and self aware enough to see this is happening to her now.

“I’m obsessed with the shape of my body and I’m embarrassed that I am still dealing with this at my age” she tells me. Though what is clear, to both her and I, is that this is not solely about her body. It’s as much, if not more to do with her mind. More specifically it’s about her emotions and ways in which she can manage them.

She tells me that she’s struggled with disordered eating and body image issues her whole life. They began when she was around 12 and she doesn’t think they ever truly left her. Throughout her adult years she was not always as thin and emaciated as she was as a teenager, so in medical terms would not have been considered anorexic. At times she says, such as after the birth of her children she may have even been considered overweight. It is difficult to tell if this is in fact true as the way she sees her own body has most likely, always been distorted. In reality, for right now, it doesn’t actually matter how much she weighed. What is clear, is that although she may not always have been dangerously thin, the obsession about the way her body looked, felt or was received by the world, never went away. She has carried this with her for decades.

This is not unusual. For many people that have suffered from eating disorders or disordered eating of any type, much of the recovery is necessarily focused on the physical. Rule number one – keep the patient alive first at foremost. So weight typically varies over time. Full recovery however is not simply weight gain but freedom from the obsession of eating or not eating, exercising or not exercising, looking 'ok' or not looking 'ok' and weighing enough or too much. Ultimately, full recovery is being convinced that regardless of how your body looks or how much you weigh, you are enough. Full recovery is freedom from obsession and unfortunately can be difficult to obtain and sometimes transient. It may be a lifelong process of learning to be ok with yourself, your feelings and yes your body. Even when it is all overwhelming.

At different periods in her life there has been freedom. Of sorts anyway. But recently there is none.

On top of her struggles she explains how difficult this is to admit. She tells me “I am 45 years old. I am a strong, independent, capable, intelligent feminist with two teenage daughters and recently, on any given day, at least 70% of my thoughts are about my body and how to change it or about food and whether or not to eat it” Her shame is visible and magnifies the already difficult emotions she is feeling. “I should know better. I do know better” she tells me. Like most women I know, young or old, she is completely aware and believes fully that a woman’s worth is not to do with her body or physical appearance. She’s completely aware that the size of her thighs or the number on her jeans has nothing to do with her worth as a human. She knows that the worth of her body is in what it can do, not what it looks like. She knows that the fact that her tummy is not as flat as it once was does not mean she is less valuable than she was. She knows all of this yet she can’t experience that truth for herself. Not right now anyway. Telling her these things only adds to the shame. Her relationship with food, her body and self-worth is complex and right now she is struggling.

Recently she can’t give her body what it needs to operate at its full capacity. She can barely eat enough to think straight. She has zero iron in her blood and her hair is falling out. On days where she does 'well' and manages to eat some meals, they come with shame and sometimes tears. A feeling of failure engulfs her. At its worst it brings disgust and self loathing. This is further compounded by her thoughts, “Really, this. Still? You’re 45 years old FFS. This is embarrassing.” And on it goes. She is consumed.

External stressors have reinforced this old method of coping. A devastating relationship breakdown she didn’t see coming, family conflict and a custody battle all while extending herself into a new business after a recent relocation interstate, have lead her here. Wandering if she’s good enough. Wandering if she’s too much. She is overwhelmed. Completely. In a way, she is starving her feelings. Her needs. It works for a while as hunger leaves her numb. Disconnected.

She longs to be smaller. To disappear. Her internal narrative tells her “Small is good. Don’t ask for too much. Don’t need too much. Don’t feel too much. Ignore your own needs. Don’t be too demanding. Don’t be too needy. Don’t be too much. Be less. Need less. Eat less. Feel less. Be smaller. Be. Smaller. Be. Smaller.” As I hear this story come through in our sessions I recognise this is not her own voice. But the voice of others. She will get to know this in time and from there, the healing may begin.

But for now, it’s painful and she’s tired. She’s unwilling to let it go because despite all of the logic and the knowledge she has, the thought of being bigger fills her with terror. Gaining weight feels like falling apart. Losing control. Admitting failure and she does not feel safe enough to do any of that right now. The restriction of the food feels like power. The hunger like a drug. Both giving her a sense of control in a time where she feels completely powerless.

In time, through therapy we will unpack the narrative in this thinking. The relationships between thinness and power, neediness and shame, restriction and control. She will learn that it is ok to have needs. That having needs do not make her needy and she may even learn that it is in fact ok to be needy sometimes. Self-sufficiency has long been viewed as a strength of hers and thus, anything less feels like failure. She wasn’t born this way however and although disordered eating is complex, unpacking how she came to believe that, will start a process in which she may begin to feel ok about needing things: Food. Love. People. Help. She will learn that embracing these needs does not make her less powerful but in fact, powerful beyond measure. She will learn to care for herself. The goal is the same goal for so many women I work with: To love herself completely.

There is no magical solution to disordered eating and its different for everyone. But people don’t arrive at a certain weight where all of their emotions suddenly feel manageable. Though, this is often the delusion, this is not the reality. Left untreated disordered eating goes on and on. At times it may be better and eating can begin to look more normal. Inevitably as this happens though, individuals begin to gain weight and the self-loathing and obsession begin to creep in again. They may at times find a great balance and become fit and strong and healthy. But in my experience, without work, without healing, there will always be obsession. For some, that may be as good as it gets. They may carry their obsession with food and weight around their entire life going in and out of the cycle constantly. Disordered eating is not a personal failing or an obsession with vanity. It is complex. and will take time and some challenging work to address its underlying causes but for those who want to break the cycle, there is hope in Psychotherapy.

The first step is to admit that it is a problem. Release the shame of thinking you “should know better”. Let go of the embarrassment. Stop pretending to be ok or denying you may be suffering because you’re “too old” or not “thin enough”. Replace it with compassion for yourself. Know you are not alone. Many women in their 30’s 40’s and 50’s feel this way and have done so for decades without seeking support.

Find a therapist you feel safe with and ask for help because you are totally worth it.

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